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Search Intelligence

On August 13, 2015, the Centers for Medicare & Medicaid Services (CMS) issued instructions to Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) regarding the scope of review for redeterminations and reconsiderations. See CMS MLN SE1521. This updated instruction applies to redetermination and reconsideration requests received by a MAC or QIC on or after August 1, 2015 and will not be applied retroactively.

This change will likely result in fewer denials at Redetermination and Reconsideration, thereby relieving some of the ongoing backlog at the Administrative Law Judge review level.